Affiliation:
1. Department of Clinical Pharmacy, College of Pharmacy University of Michigan Ann Arbor Michigan USA
2. Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA
3. Center for Gerontology and Healthcare Research Brown University School of Public Health Providence Rhode Island USA
4. Department of Health Services, Policy, and Practice Brown University School of Public Health Providence Rhode Island USA
5. Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA
6. Center of Innovation in Long‐Term Services and Supports Providence Veterans Affairs Medical Center Providence Rhode Island USA
7. Department of Psychiatry University of Michigan Ann Arbor Michigan USA
8. Department of Neurology The Warren Alpert Medical School of Brown University Providence Rhode Island USA
9. Department of Internal Medicine University of Michigan Ann Arbor Michigan USA
Abstract
AbstractBackgroundAntipsychotic and other psychotropic medication use is prevalent among community‐dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.MethodsAmong community‐dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee‐for‐service claims using interrupted time series analyses across three periods (“Pre‐Partnership”: July 1, 2010 to March 31, 2012; “Post‐Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).ResultsWe included 1,289,401 community dwellers with dementia contributing 26,609,697 person‐months. The mean age was 80 years, most were female (70%), approximately 80% were non‐Hispanic Whites, 10% were non‐Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre‐Partnership (β = −0.06, 95% CI: −0.08, −0.05) and post‐Partnership (β = −0.02, 95% CI: −0.02, −0.01). Post‐Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community‐dwelling older adults with dementia.ConclusionsThese two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community‐dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community‐dwellers with dementia.
Funder
National Institute on Aging